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NEURORADIOLOGY Table of Contents   
Year : 2005  |  Volume : 15  |  Issue : 3  |  Page : 325-326
Tubercular radiculomyelitis - uncommon presentation


Department Of Radiology, St. John's Medical College And Hospital,Bangalore-560034, India

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Keywords: Tubercular Radiculomyelitis - MRI

How to cite this article:
Swamy S, Pavan K V, Devi R, Sethumadhavan P S. Tubercular radiculomyelitis - uncommon presentation. Indian J Radiol Imaging 2005;15:325-6

How to cite this URL:
Swamy S, Pavan K V, Devi R, Sethumadhavan P S. Tubercular radiculomyelitis - uncommon presentation. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Sep 23];15:325-6. Available from: http://www.ijri.org/text.asp?2005/15/3/325/29146

   Introduction Top


Tubercular arachnoiditis and radiculomyelitis is an important and potentially treatable cause of infectious arachnoiditis [1]. While tubercular infection is common in third world countries, it is also showing an increasing trend in the west, because of a high prevalence of AIDS. We report an uncommon occurrence of this condition in an infant with no other detectable primary site of infection or evidence of seroconversion. In such a situation a high index of suspicion should be entertained lest a potentially treatable condition is overlooked.


   Case report Top


A nine-month male child was brought with a history of developmental delay and seizures. Child had a history of jerky limb movements since the age of one month, which was diagnosed as epilepsy and the child was put on antiepileptic medication. Now child was presenting with delayed motor milestones and lower limb weakness. There is also a history of straining at stools and during micturition.

Physical exam revealed microcephaly and hypotonia in the lower limbs. Reflexes were normal. Rest of the systemic examination was normal. Lab investigations were nonspecific except for anemia with a Hb of 9 and ESR of 20. Child was Mantoux negative.

Plain MR Imaging of the dorsolumbar spine was performed. T1W saggital and axial images showed increased signal intensity of the CSF with loss of outline of the cord and cauda equina [Figure - 1][Figure - 2]. T2W images revealed thickening and clumping of nerve roots with irregular isointense nodules in the dorsolumbar subarachnoid space [Figure - 3][Figure - 4]. Scattered CSF loculations were also seen. The vertebral bodies and disc spaces showed normal signal. No paravertebral masses were seen. Based on these imaging findings a differential diagnosis of tuberculous arachnoiditis vs. drop metastases from intracranial tumor was made. Patient underwent laminectomy D11 to L1. After opening the dura, greyish brown soft tissue was found adherent to the nerve roots, which was excised. Histopathology of the tissue revealed necrotizing granulomatous inflammation typical of tuberculosis.


   Discussion Top


Spinal arachnoiditis refers to an inflammatory process of the leptomeninges that has varied etiology including infection, intrathecal administration of contrast, antibiotics or anesthetic agents, subarachnoid hemorrhage, trauma, surgery and disc disease. Tuberculosis is reported to be the most common and potentially treatable cause.

The most frequent route of tuberculous radiculomyelitis has been postulated to be hematogenous spread from a source outside the CNS [2]. Less common routes of spread are secondary extension of cranial tuberculous meningoencephalomyelitis or intraspinal extension from osseous tuberculosis [3].

Clinical features depend on the site of involvement and may be variable including paraplegia, quadriplegia, radicular pain and bowel and bladder disturbances. Prompt treatment ensures good recovery [4].

MR imaging plays an important role in the diagnosis of this entity. Ability to image whole spine irrespective of myelographic block is important as this condition often involves long segments of the thecal sac. Also excellent contrast resolution allows for delineation of the exact cause of cord compression [5].

The imaging features on MR include increased signal intensity of CSF on T1W images due to elevated protein content of CSF which leads to decreased or complete loss of cord outline on T1W images. Arachnoid bands may cause irregular CSF loculations. Thickening and clumping of nerve roots may be seen. Nodules in the subarachnoid space may represent tuberculomas or fibrotic masses. Signal intensity changes on T2W images include cord edema, ischemia, myelomalacia and cord cavitation [5],[6].

The illustrated case of tubercular radiculomyelitis in an infant is indicative of the high index of suspicion that must be entertained for the diagnosis of this condition in case of unusual presentations.

 
   References Top

1.Medonca RA.Spinal infection and inflammatory disorders.MRI of the Brain and Spine, Scott W. Atlas, Vol II, IIIrd ed. Lippincott, Williams & Wilkins, 1855-1969.  Back to cited text no. 1    
2.Wadia NH, Dastur DK. Spinal meningitis with radiculomyelopathy, part I. Clinical and radiological features. J Nerol Sci. 1969:8: 239-260  Back to cited text no. 2    
3.Wadia NH. Radiculomyelopathy associated with spinal meningitis with special reference to spinal TB variety. In Spillane JD(ed) Tropical Neurology, London, Oxford Univ Press. 1973:63-72.  Back to cited text no. 3    
4.Phadke RN, Kohli A, Jain VK etal. Tuberculous radiculomyelitis (arachnoiditis): Myelographic (and CT Myelographic) appearances. Australas Radiol. 1994:38:10-16.  Back to cited text no. 4    
5.Sharma A, Goyal M, Mishra NK, Gupta V et al. MR Imaging of Tubercular Spinal Arachnoiditis. Am J Roentgenol 1997;168:807-812.  Back to cited text no. 5    
6.J Randy Jinkins, Rakesh Gupta, Kee Hyun Chang, Jesus Rodriguez-Caribjal. MR Imaging of CNS Tuberculosis, Rad clinics of N Amr, 1995:33:805-820.  Back to cited text no. 6    

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Correspondence Address:
S Swamy
Department Of Radiology,St. John's Medical College And Hospital,Bangalore - 560034
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29146

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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    Introduction
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